Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case–control study

Abstract

Background:It is well established that screening can prevent cervical cancer, but the magnitude of the impact of regular screening on cervical cancer mortality is unknown.Methods:Population-based case–control study using prospectively recorded cervical screening data, England 1988–2013. Case women had cervical cancer diagnosed during April 2007–March 2013 aged 25–79 years (N=11 619). Two cancer-free controls were individually age matched to each case. We used conditional logistic regression to estimate the odds ratio (OR) of developing stage-specific cancer for women regularly screened or irregularly screened compared with women not screened in the preceding 15 years. Mortality was estimated from excess deaths within 5 years of diagnosis using stage-specific 5-year relative survival from England with adjustment for age within stage based on SEER (Surveillance, Epidemiology and End Results, USA) data.Results:In women aged 35–64 years, regular screening is associated with a 67% (95% confidence interval (CI): 62–73%) reduction in stage 1A cancer and a 95% (95% CI: 94–97%) reduction in stage 3 or worse cervical cancer: the estimated OR comparing regular (⩽5.5yearly) screening to no (or minimal) screening are 0.18 (95% CI: 0.16–0.19) for cancer incidence and 0.08 (95% CI: 0.07–0.09) for mortality. It is estimated that in England screening currently prevents 70% (95% CI: 66–73%) of cervical cancer deaths (all ages); however, if everyone attended screening regularly, 83% (95% CI: 82–84%) could be prevented.Conclusions:The association between cervical cancer screening and incidence is stronger in more advanced stage cancers, and screening is more effective at preventing death from cancer than preventing cancer itself.

Hysterectomy‐corrected cervical cancer mortality rates in Denmark during 2002‐2015: A registry‐based cohort study

“…These findings call for action, particularly because women aged 65 years and older are not recommended for screening for cervical cancer in the majority of European countries, including Denmark. Cervical cancer screening is associated with a lower risk of advanced stage disease and cervical cancer death . Although the sensitivity of screening may decline with age, screening beyond the age of 65 years may reduce cervical cancer incidence and mortality .…”

“…Every year, 375 women are diagnosed with cervical cancer in Denmark and 100 women die from the disease . The mortality of cervical cancer has declined significantly in Denmark after the implementation of cervical cancer screening, which is likely a result of an overall reduction in cervical cancer incidence and because more cases are detected as early stage disease . Despite the fact that Danish women are invited for cervical cancer screening regularly and free of charge, the survival rates of cervical cancer remain lower in Denmark than in the other North European countries, such as Norway, Germany and the Netherlands …”

Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

“…Organised cervical cancer screening has led to a noticeable reduction in the incidence of and mortality from invasive cervical cancer, as pre-invasive lesions (cervical intraepithelial neoplasia, CIN) can be detected and treated appropriately 12. Low grade squamous intraepithelial lesion (LSIL, also known as CIN1) is now recognised as a histological diagnosis of benign viral replication that should be managed conservatively, whereas CIN3 is recognised as a true pre-invasive precursor with a potential to progress to cancer.…”

It’s hard to reach the “hard-to-reach”: the challenges of recruiting people who do not access preventative healthcare services into interview studies

“…Members of “hard-to-reach” groups tend to have poorer health outcomes than those who utilise preventative healthcare services (Hewitson, Glasziou, Watson, Towler, & Irwig, 2008; Landy, Pesola, Castanon, & Sasieni, 2016; Weedon-Fekjær, Romundstad, & Vatten, 2014). These groups would therefore benefit the most from interventions to increase uptake of the services available to them.…”